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      Increasing influenza vaccination coverage in healthcare workers: a review on campaign strategies and their effect

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          Abstract

          Purpose

          Increasing influenza vaccination coverage in healthcare workers is a challenge. Especially during the ongoing COVID-19 pandemic, high vaccination coverage should be attained. This review analyzed strategies to increase influenza vaccination coverage in healthcare workers.

          Methods

          A literature search using PubMed was conducted and 32 publications on influenza vaccination campaigns for healthcare workers were reviewed for key interventions and resulting vaccination coverage.

          Results

          Among key interventions analyzed, mandatory vaccination policies or multifaceted campaigns including a vaccinate-or-wear-a-mask policy as well as mandatory declination reached vaccination coverage in healthcare workers of over 90%. Although campaigns solely based on education and promotion or on-site-vaccination did not regularly exceed an absolute vaccination coverage of 40%, a substantial relative increase in vaccination coverage was reached by implementation of these strategies.

          Conclusion

          Mandatory vaccination policies are effective measures to achieve high overall vaccination coverage. In clinics where policies are infeasible, multifaceted campaigns comprising on-site vaccination, vaccination stands and educational and promotional campaigns as well as incentives should be implemented. Lessons learned from influenza campaigns could be implemented in future SARS-CoV-2 vaccination campaigns.

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          Most cited references41

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          Estimates of global seasonal influenza-associated respiratory mortality: a modelling study

          Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000-500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999-2015.
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            The Natural History of Influenza Infection in the Severely Immunocompromised vs Nonimmunocompromised Hosts

            Severely immunocompromised individuals infected with influenza are different from the influenza infected that are nonimmunocompromised. Issues to consider during medical management include asymptomatic shedding, development of multi-drug resistance during prolonged antiviral therapy, and the potential high risk of pulmonary involvement.
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              Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis.

              Influenza vaccination is recommended for healthcare workers (HCWs), but coverage is often low. We reviewed studies evaluating interventions to increase seasonal influenza vaccination coverage in HCWs, including a meta-regression analysis to quantify the effect of each component. Fourty-six eligible studies were identified. Domains conferring a high risk of bias were identified in most studies. Mandatory vaccination was the most effective intervention component (Risk Ratio of being unvaccinated [RRunvacc] = 0.18, 95% CI: 0.08-0.45), followed by "soft" mandates such as declination statements (RRunvacc = 0.64, 95% CI: 0.45-0.92), increased awareness (RRunvacc = 0.83, 95% CI: 0.71-0.97) and increased access (RRunvacc = 0.88, 95% CI: 0.78-1.00). For incentives the difference was not significant, while for education no effect was observed. Heterogeneity was substantial (τ(2) = 0.083). These results indicate that effective alternatives to mandatory HCWs influenza vaccination do exist, and need to be further explored in future studies.
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                Author and article information

                Contributors
                Oliver.Cornely@uk-koeln.de
                Journal
                Infection
                Infection
                Infection
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0300-8126
                1439-0973
                7 December 2020
                7 December 2020
                : 1-13
                Affiliations
                [1 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), , University of Cologne, ; Herderstraße 52-54, 50931 Cologne, Germany
                [2 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), , Chair Translational Research, University of Cologne, ; Cologne, Germany
                [3 ]GRID grid.452463.2, German Centre for Infection Research (DZIF), ; Partner Site Bonn-Cologne, Cologne, Germany
                [4 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), , University of Cologne, ; Cologne, Germany
                [5 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, Center for Molecular Medicine Cologne (CMMC), , University of Cologne, ; Cologne, Germany
                Author information
                http://orcid.org/0000-0002-8805-1421
                http://orcid.org/0000-0002-6766-8297
                http://orcid.org/0000-0001-9599-3137
                http://orcid.org/0000-0003-3928-2503
                Article
                1555
                10.1007/s15010-020-01555-9
                7720031
                33284427
                b4ea7746-3c35-403e-93a7-e60030fbf04e
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 1 October 2020
                : 6 November 2020
                Funding
                Funded by: Universitätsklinikum Köln (8977)
                Categories
                Review

                Infectious disease & Microbiology
                healthcare personnel,seasonal influenza,influenza virus,immunization,vaccine uptake rate,immunization programs

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